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Hospitals have remained consistent in their share of health care expenditures despite dramatic changes in the payment and financing of care, including the passage of the Patient Protection and Affordable Care Act. This commentary discusses how they have done this and what it portends for health care reform.

Authors’ analysis using data from Medicare Annual Beneficiary Summary Files, 2000–2010. Analysis excludes patients enrolled in Medicare Part A for fewer than 12 mo or those enrolled in any HMO plan. Adjusted for inflation and shown in 2005 U.S. dollars. Includes spending from hospitals and other institutional providers (for example, rural and federally qualified health centers), although more than 95% of spending was from hospital outpatient departments.

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